Guidelines for antenatal and preoperative care in cesarean delivery: Enhanced Recovery After Surgery Society recommendations (part 1)—2025 update

May combine two claims.

Preoperative anemia has been shown to increase the perioperative morbidity and mortality rates, and postpartum anemia itself can affect recovery.

“Furthermore, preoperative anemia has been shown to increase the perioperative morbidity and mortality rates, and postpartum anemia itself can affect recovery.61,62”

• cites [61] Milman, 2012, Postpartum anemia II: prevention and treatment, Ann Hematol sourceNot checked — no full text of the source
• cites [62] Butwick, 2017, Patterns and predictors of severe postpartum anemia after Cesarean section, Transfusion sourcePartly supported

  The Introduction (page unavailable) links postpartum anemia to depression, fatigue and impaired cognition, supporting the claim that it can affect recovery. The Discussion (page unavailable) identifies predelivery anemia as a risk factor for severe postpartum anemia after cesarean section, but does not say that preoperative anemia increases perioperative morbidity or mortality rates. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

May combine two claims.

The goal of treatment is to prevent severe hypertension and superimposed preeclampsia, which can lead to severe end-organ dysfunction that affects intraoperative and postoperative care; with adequate treatment of mild to moderate hypertension in pregnancy, the progression to severe hypertension can be reduced by as much as 50%.

“The goal of treatment is to prevent severe hypertension and superimposed preeclampsia, which can lead to severe end-organ dysfunction that affects intraoperative and postoperative care; with adequate treatment of mild to moderate hypertension in pregnancy, the progression to severe hypertension can be reduced by as much as 50%.97,98”

• cites [97] Abalos, 2018, Antihypertensive drug therapy for mild to moderate hypertension during pregnancy, Cochrane Database Syst Rev sourcePartly supported

  Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  Experimental — accuracy not yet measured
• cites [98] Seely, 2011, Chronic hypertension in pregnancy, N Engl J Med sourceNot checked — no full text of the source

May combine two claims.

Recent RCTs and reviews have shown that every other day dosing of oral iron supplementation may be as effective as daily or more frequent dosing with fewer side effects, although more data are needed to establish the optimal dosing regimens.

“Recent RCTs and reviews have shown that every other day dosing of oral iron supplementation may be as effective as daily or more frequent dosing with fewer side effects, although more data are needed to establish the optimal dosing regimens.64,65”

• cites [64] O’Toole, 2024, Screening and treatment of iron deficiency anemia in pregnancy: a review and appraisal of current international guidelines, Int J Gynaecol Obstet sourcePartly supported

  Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  Experimental — accuracy not yet measured
• cites [65] James, 2021, Iron deficiency anemia in pregnancy, Obstet Gynecol sourceNot checked — no full text of the source

May combine two claims.

RCT results focused on the implementation of a decision aid among patients with a history of cesarean delivery found that the use of the decision aid was not substantially associated with decision quality regarding the mode of delivery, nor with clinical outcomes.

“RCT results focused on the implementation of a decision aid among patients with a history of cesarean delivery found that the use of the decision aid was not substantially associated with decision quality regarding the mode of delivery, nor with clinical outcomes.54”

• cites [54] Kuppermann, 2020, Effect of a patient-centered decision support tool on rates of trial of labor after previous Cesarean delivery: the PROCEED randomized clinical trial, JAMA sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Propensity score analysis of a large, international, cross-sectional cohort revealed that severe anemia (hemoglobin <7 g/dL) was associated with increased odds of patient death (adjusted odds ratio, 1.86; 95% CI, 1.39-2.49), but aside from preceding death, the exact timing of when the anemia laboratory results were obtained was not reported.

“Propensity score analysis of a large, international, cross-sectional cohort revealed that severe anemia (hemoglobin <7 g/dL) was associated with increased odds of patient death (adjusted odds ratio [aOR], 1.86; 95% CI, 1.39e2.49),but aside from preceding death, the exact timing of when the anemia laboratory results were obtained was not reported.63”

• cites [63] Daru, 2018, Risk of maternal mortality in women with severe anaemia during pregnancy and post partum: a multilevel analysis, Lancet Glob Health sourceSupported

May combine two claims.

Chronic hypertension, particularly when not well controlled, increases the incidence of preeclampsia, cesarean delivery, preterm birth, placental abruption, and fetal complications, such as fetal growth restriction and stillbirth.

“Chronic hypertension, particularly when not well controlled, increases the incidence of preeclampsia, cesarean delivery, preterm birth, placental abruption, and fetal complications, such as fetal growth restriction and stillbirth.95,96”

• cites [95] 2018, ACOG practice bulletin no. 203: chronic hypertension in pregnancy, Obstet GynecolNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [96] Bramham, 2014, Chronic hypertension and pregnancy outcomes: systematic review and meta-analysis, BMJ sourcePartly supported

  The Abstract (page not specified) reports higher risks of pre-eclampsia, caesarean delivery, preterm delivery, low birth weight, and perinatal death among women with chronic hypertension. The Data extraction section defines perinatal death to include stillbirth, but the paper does not separately establish increased stillbirth or fetal growth restriction. Placental abruption appears in reference titles rather than the reported outcomes, and the paper does not establish the claim's emphasis on poorly controlled hypertension. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

May combine two claims.

The most common cause of pregnant patient anemia is iron deficiency, however, a workup for other potential causes is recommended.

“The most common cause of pregnant patient anemia is iron deficiency, however, a workup for other potential causes is recommended.64”

• cites [64] O’Toole, 2024, Screening and treatment of iron deficiency anemia in pregnancy: a review and appraisal of current international guidelines, Int J Gynaecol Obstet sourcePartly supported

  The Introduction (page unavailable) calls iron-deficiency anemia the leading cause of anemia, supporting the first part of the claim. The Results table (page unavailable) reports evaluation for other causes under particular conditions, including ruling out thalassemia and vitamin B12 deficiency when ferritin is above a threshold or investigating a failure to respond to iron. It does not recommend a workup for other causes in every pregnant patient with anemia. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The author group was based on international expertise in the area, and the guideline methodology followed that endorsed by the ERAS Society, as published previously.

“The author group was based on international expertise in the area, and the guideline methodology followed that endorsed by the ERAS Society, as published previously.11”

• cites [11] Brindle, 2020, Recommendations from the ERAS® Society for standards for the development of enhanced recovery after surgery guidelines, BJS Open sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

A codesign workshop that involved healthcare providers and patients recommended initiating discussion about mode of delivery at the 16-week appointment and finalizing the birth plan by 28 weeks, while still providing opportunities for patients to request changes up to the time of delivery.

“A codesign workshop that involved healthcare providers and patients recommended initiating this discussion at the 16-week appointment and finalizing the birth plan by 28 weeks (while still providing opportunities for patients to request changes up to the time of delivery).55”

• cites [55] Kenyon, 2016, Improving the care pathway for women who request Caesarean section: an experience-based co-design study, BMC Pregnancy Childbirth sourceSupported

May combine two claims.

Prolonged preoperative fasting (traditionally described as nothing by mouth after midnight) is not recommended and may lead to hypovolemia, hypoglycemia, ketoacidosis, and decreased patient satisfaction.

“Prolonged preoperative fasting (traditionally described as nothing by mouth after midnight) is not recommended and may lead to hypovolemia, hypoglycemia, ketoacidosis, and decreased patient satisfaction.144,145”

• cites [144] Joshi, 2023, Anesthesiology sourcePartly supported

  The Summary recommends clear liquids until 2 hours before surgery, and the Comment links prolonged fasting to dehydration, hypotension, and reduced well-being. The paper reports higher satisfaction with carbohydrate-containing liquids than with noncaloric liquids, but its fasting comparison does not establish a satisfaction difference. Our copy does not identify hypoglycemia or ketoacidosis as consequences of prolonged fasting. (LLM, conf=0.85)

  Experimental — accuracy not yet measured
• cites [145] Bollag, 2021, Society for Obstetric Anesthesia and Perinatology: consensus statement and recommendations for Enhanced Recovery after Cesarean, Anesth Analg sourceNot checked — no full text of the source

May combine two claims.

Pregnant patient's anxiety before surgery was also a commonly studied outcome but, again, the consistent effects of nonparticulate CHO drinks on reducing anxiety was not observed.

“Pregnant patient's anxiety before surgery was also a commonly studied outcome but, again, the consistent effects of nonparticulate CHO drinks on reducing anxiety was not observed.165,166,168,169”

• cites [165] Clark, 2021, Pre-operative carbohydrate loading prior to elective caesarean delivery: a randomised controlled trial, Int J Obstet Anesth sourceNot checked — no full text of the source
• cites [166] Sharma, 2024, Role of preoperative carbohydrate loading for prevention of perioperative ketoacidosis in elective cesarean delivery, J Anaesthesiol Clin Pharmacol sourcePartly supported

  The Material and Methods section reports that preoperative anxiety was measured in parturients given a nonparticulate carbohydrate drink or water. The Results and Discussion report significantly lower anxiety scores in the carbohydrate group. This trial therefore supports anxiety as a studied outcome, but it does not establish the citing sentence’s conclusion that effects were inconsistent across studies. (LLM, conf=0.85)

  Experimental — accuracy not yet measured
• cites [168] Shi, 2021, Effect of preoperative oral carbohydrate administration on patients undergoing cesarean section with epidural anesthesia: a pilot study, J Perianesth Nurs sourceNot checked — no full text of the source
• cites [169] Thakur, 2024, Preoperative oral carbohydrate-containing fluid versus plain water in elective cesarean deliveries: a randomized clinical trial, J Perianesth Nurs sourceNot checked — no full text of the source

May combine two claims.

One study found that preoperative nonparticulate CHO drinks shortened the time to the expression of colostrum and 1 found increased frequency and duration of breastfeeding associated with nonparticulate CHO drinks.

“One study found that preoperative nonparticulate CHO drinks shortened the time to the expression of colostrum 167 and 1 found increased frequency and duration of breastfeeding 171 associated with nonparticulate CHO drinks.”

• cites [167] Cheng, 2022, The effect of preoperative oral carbohydrate on the time to colostrum and amount of vaginal bleeding after elective cesarean section, J Obstet Gynaecol Res sourceSupported
• cites [171] Fard, 2018, The effect of preoperative oral carbohydrate on breastfeeding after Cesarean section: a double-blind, randomized controlled clinical trial, J Diet Suppl sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Antiseptic skin cleaning processes have been used in the pre-admission and early preoperative periods before various surgical procedures with most available evidence reported for orthopedic, gastrointestinal, and gynecologic surgeries.

“Antiseptic skin cleaning processes have been used in the pre-admission and early preoperative periods before various surgical procedures with most available evidence reported for orthopedic, gastrointestinal, and gynecologic surgeries.137”

• cites [137] Boyce, 2023, Best products for skin antisepsis, Am J Infect Control sourcePartly supported

  The Preoperative Bathing discussion (page not available in our copy) describes bathing before admission or on the night before or day of surgery, and lists orthopedic, colorectal, hysterectomy, and Cesarean procedures. It does not establish that most available evidence concerns orthopedic, gastrointestinal, and gynecologic surgery rather than other procedures. (LLM, conf=0.84)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

The mean (standard deviation) age at delivery for pregnant patients with epilepsy was 29.9 (5.3) years.

“The mean (standard deviation) age at delivery for pregnant patients with epilepsy was 29.9 (5.3) years.131”

• cites [131] Razaz, 2024, Risk of perinatal and maternal morbidity and mortality among pregnant women with epilepsy, JAMA Neurol sourceSupported

May combine two claims.

The benefits of preoperative nonparticulate CHO drinks seem to be clear in cardiac surgery and, to a lesser extent, in general abdominal surgery.

“The benefits of preoperative nonparticulate CHO drinks seem to be clear in cardiac surgery 159 and, to a lesser extent, in general abdominal surgery.160e163”

• cites [159] Kotfis, 2020, The effect of preoperative carbohydrate loading on clinical and biochemical outcomes after cardiac surgery: a systematic review and meta-analysis of randomized trials, Nutrients sourceSupported
• cites 160e163Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

Epilepsy during pregnancy and the use of ASM have been associated with increased morbidity, perinatal mortality, and morbidity in patients with epilepsy.

“Epilepsy during pregnancy and the use of ASM have been associated with increased morbidity, perinatal mortality, and morbidity in patients with epilepsy.131”

• cites [131] Razaz, 2024, Risk of perinatal and maternal morbidity and mortality among pregnant women with epilepsy, JAMA Neurol sourceSupported

May combine two claims.

Two studies (1 RCT) evaluated postoperative maternal ketosis; 1 study found that ketosis was reduced in the nonparticulate CHO drink intervention group.

“Two studies (1 RCT) evaluated postoperative maternal ketosis; 1 study found that ketosis was reduced in the nonparticulate CHO drink intervention group.165,166”

• cites [165] Clark, 2021, Pre-operative carbohydrate loading prior to elective caesarean delivery: a randomised controlled trial, Int J Obstet Anesth sourceNot checked — no full text of the source
• cites [166] Sharma, 2024, Role of preoperative carbohydrate loading for prevention of perioperative ketoacidosis in elective cesarean delivery, J Anaesthesiol Clin Pharmacol sourcePartly supported

  The Results report fewer positive urine-ketone tests in the carbohydrate-drink group than in the water group (1.7% versus 8.3%), but the difference was not statistically significant (P = 0.094). The Discussion says urine ketones were measured immediately before surgery, not postoperatively. The Methods identify the drink as nonparticulate and the study as randomized. (LLM, conf=0.89)

  Experimental — accuracy not yet measured

May combine two claims.

Two trials reported less neonatal hypoglycemia with preoperative nonparticulate CHO drinks, although the number of infants with hypoglycemia was small.

“Neonatal outcomes were not commonly studied, but 2 trials reported less neonatal hypoglycemia with preoperative nonparticulate CHO drinks, although the number of infants with hypoglycemia was small.114,172”

• cites [114] Liu, 2021, Safety and feasibility of oral carbohydrate consumption before cesarean delivery on patients with gestational diabetes mellitus: a parallel, randomized controlled trial, J Obstet Gynaecol Res sourceNot checked — no full text of the source
• cites [172] Kotfis, 2023, Preoperative oral carbohydrate (CHO) supplementation is beneficial for clinical and biochemical outcomes in patients undergoing elective cesarean delivery under spinal anaesthesia-a randomized controlled trial, J Clin Med sourcePartly supported

  The Results (§3.5; page unavailable) report that no newborn in the CHO group required additional oral glucose, compared with six in the fasting group. The authors distinguish glucose administration during the first 24 hours from hypoglycemia measured immediately after birth, so those counts do not establish that fewer infants had hypoglycemia. The Methods (§2.4; page unavailable) confirm that this trial used a preoperative carbohydrate drink; this source is one trial, not both trials cited in the sentence. (LLM, conf=0.83)

  Experimental — accuracy not yet measured

May combine two claims.

Medical comorbidity evidence, although strong for the patient's clinical optimization opportunity, has not been directly evaluated against cesarean delivery.

“Medical comorbidity evidence, although strong for the patient's clinical optimization opportunity, has not been directly evaluated against cesarean delivery; therefore, a decision was made to evaluate the group of conditions as an overall composite and individualized consideration for their”

May combine two claims.

Optimization of a pregnant patient with comorbidities can provide evidence and recommendations for patient benefit; however, there is no direct evidence that optimization of these selected conditions affects the likelihood or risk of cesarean delivery.

“Optimization of a pregnant patient with comorbidities can provide evidence and recommendations for patient benefit; however, there is no direct evidence that optimization of these selected conditions affects the likelihood or risk of cesarean delivery.”

May combine two claims.

The preoperative nonparticulate carbohydrate drink intervention has not been shown to have clear clinically significant benefits but seems safe.

“This intervention has not been shown to have clear clinically significant benefits but seems safe.”

May combine two claims.

A nonparticulate CHO drink administered 2 hours before scheduled cesarean delivery has not been shown to have clinically significant benefits, but the intervention seems safe.

“A nonparticulate CHO drink administered 2 hours before scheduled cesarean delivery has not been shown to have clinically significant benefits, but the intervention seems safe.”

Probably not a substantial claim: may not pass S4 (based).

There is insufficient evidence for screening and supplementation for iron deficiency, in the presence or absence of anemia, during pregnancy to improve maternal and fetal health outcomes.

“Screening: there is insufficient evidence for screening and supplementation for iron deficiency, in the presence or absence of anemia, during pregnancy to improve maternal and fetal health outcomes.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

The ability to implement interventions to provide high-risk comorbidity care will differ between urban and rural sites/providers.

“In addition, the ability to implement interventions to provide high-risk comorbidity care will differ between urban and rural sites/providers.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Discrepancies were resolved by the leading and senior authors.

“Discrepancies were resolved by the leading and senior authors.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Chronic hypertension is common in the general population, which subsequently impacts the prevalence during pregnancy.

“Chronic hypertension is common in the general population, which subsequently impacts the prevalence during pregnancy.90e92”

• cites 90e92Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Classified as probably not a substantial claim. May combine two claims.

The goal of the ERAC process is to reduce surgical process variability through the implementation of evidence-based processes, thereby improving patient experience and quality of maternal and neonatal outcomes, and reducing surgery-related costs.

“The goal of the ERAC process is to reduce surgical process variability through the implementation of evidence-based processes, thereby improving the patient experience and quality of maternal and neonatal outcomes, in addition to reducing surgery-related costs.2e8”

• cites 2e8Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

Hemoglobin A1C levels can be used secondarily, however, physiological changes in red cell turnover during gestation may necessitate more frequent surveillance.

“Hemoglobin A1C levels can be used secondarily, however, physiological changes in red cell turnover during gestation may necessitate more frequent surveillance.105”

• cites [105] 2019, 14. Management of diabetes in pregnancy: standards of medical care in diabetes-2019, Diabetes CareNot checked yet

  Not checked in the free run.

May combine two claims.

Several RCTs have shown that lifestyle interventions, particularly those related to behavior counseling, dietary intake, physical activity, psychological interventions, and pharmacotherapy can reduce excess gestational weight gain in pregnancy among pregnant patients with obesity, however, the interventions studied are heterogeneous, can be intensive, and some results are mixed.

“Several RCTs have shown that lifestyle interventions, particularly those related to behavior counseling, dietary intake, physical activity, psychological interventions, and pharmacotherapy can reduce excess gestational weight gain in pregnancy among pregnant patients with obesity, however, the interventions studied are heterogeneous, can be intensive, and some results are mixed.77e83”

• cites 77e83Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Although the Delphi process adds rigor to the evidence using repetitive consensus, it has eliminated certain traditional cornerstone interventions in surgical processes and care.

“Although it adds rigor to the evidence using repetitive consensus, the Delphi process has eliminated certain traditional cornerstone interventions in surgical processes and care.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Evidence to support the nonrandomized controlled trial (RCT)-based processes for recommendations for interventions 1 to 3 is provided.

“Evidence to support the nonrandomized controlled trial (RCT)ebased processes for recommendations for interventions 1 to 3 is provided.38e46”

• cites 38e46Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The Core ERAC Team reviewed the evidence in detail for each section and assigned both the recommendation and evidence levels.

“The Core ERAC Team (P.S., G.N., A.B.C., G.A.M., and R.D.W.) reviewed the evidence in detail for each section and assigned both the recommendation and evidence levels.”

Classified as probably not a substantial claim. May combine two claims.

Optimizing gestational weight gain can help at the time of cesarean delivery, because surgical complexity in the presence of obesity necessitates directed delivery planning to optimize the surgical approach.

“Optimizing gestational weight gain can help at the time of cesarean delivery, because surgical complexity in the presence of obesity necessitates directed delivery planning to optimize the surgical approach.”

May combine two claims.

Several RCTs and meta-analyses have shown that active diabetes treatment is feasible and effective in pregnancy and reduces the rate of complications, especially if started early.

“Several RCTs and meta-analyses have shown that active diabetes treatment is feasible and effective in pregnancy and reduces the rate of complications, especially if started early.109e113”

• cites 109e113Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

An updated literature search was conducted in September 2024 using Embase, PubMed, MEDLINE, EBSCO CINAHL, Scopus, and Web of Science databases.

“An updated literature search was conducted in September 2024 using the Embase, PubMed, MEDLINE, EBSCO CINAHL (Cumulative Index of Nursing and Allied Health Literature), Scopus, and Web of Science databases.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The reference lists of all eligible articles were cross-checked with those of other relevant studies.

“The reference lists of all eligible articles were cross-checked with those of other relevant studies.”

May combine two claims.

The increasing use of evidence for remote multisite or provider collaborative care is clinically effective and fiscally feasible.

“The increasing use of evidence for remote multisite or provider collaborative care is clinically effective and fiscally feasible.47e52”

• cites 47e52Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The ERAC process requires maternity provider and patient acceptance, along with health service implementation and sustainability support for more supportive evidence.

“The ERAC process requires maternity provider and patient acceptance, along with health service implementation and sustainability support for more supportive evidence.2,13e21”

• cites 2,13e21Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Anemia during pregnancy has been identified in 12% of pregnant patients in high-income countries and may affect up to 50% of pregnant patients in low- and middle-income countries and is associated with increases in patient morbidity and mortality, with notable racial and ethnic disparities.

“Anemia during pregnancy has been identified in 12% of pregnant patients in high-income countries and may affect up to 50% of pregnant patient in lowand middle-income countries and is associated with increases in patient morbidity and mortality, with notable racial and ethnic disparities.58e60”

• cites 58e60Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Classified as probably not a substantial claim. May combine two claims.

The ERAC focus is more complex than traditional ERAS because there are two or more patients involved, a longer gestational opportunity (10-42 weeks), and no direct peer-reviewed evidence showing a direct impact on pregnant patient and fetal outcomes related to cesarean delivery.

“The ERAC focus is more complex, because there are 2 (or more) patients involved, a longer length of gestational opportunity (10-42 gestational weeks) for the provider/team to manage the pregnant patient and fetal health, and the added difficulty of not having direct peer-reviewed evidence that has shown a direct impact on the pregnant patient and fetal outcomes related to a cesarean delivery.”

May combine two claims.

A systematic review that included 22 reviews demonstrated that pregnant patient obesity (BMI >30 kg/m2) substantially increased the incidence of gestational diabetes mellitus, hypertensive disorders, mental health conditions, cesarean delivery, and surgical site infections, as well as fetal complications; these complication rates increased as the BMI increased.

“A systematic review that included 22 reviews demonstrated that pregnant patient obesity (body mass index [BMI] >30 kg/m 2 ) substantially increased the incidence of gestational diabetes mellitus (GDM), hypertensive disorders, mental health conditions, cesarean delivery, and surgical site infections, as well as fetal complications; these complication rates increased as the BMI increased.76”

• cites [76] Marchi, 2015, Risks associated with obesity in pregnancy, for the mother and baby: a systematic review of reviews, Obes Rev sourceNot checked — no full text of the source

Classified as probably not a substantial claim.

Targeted searches were performed by a medical librarian to identify relevant articles published since the 2018 ERAS Society guidelines, focusing on randomized clinical trials and large observational studies (>800 patients).

“Targeted searches were performed by a medical librarian to identify relevant articles published since the 2018 Enhanced Recovery After Surgery Society guidelines publication, which evaluated each antenatal and preoperative enhanced recovery after cesarean delivery intervention, focusing on randomized clinical trials and large observational studies (!800 patients) to maximize search feasibility and”

Classified as probably not a substantial claim.

The quality of evidence and recommendations was evaluated according to the GRADE system.

“As outlined in Table 1, the quality of the evidence and recommendations was evaluated according to the Grading of Recommendations, Assessment, Development, and Evaluation system, 12 as described in the previous ERAS Guidelines.”

• cites [12]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Enhanced recovery after cesarean delivery (ERAC) was introduced in 2013 and has been incorporated into many scheduled surgical pathways.

“Enhanced recovery after cesarean delivery (ERAC) was introduced in 2013 and has been incorporated into many scheduled surgical pathways.1”

• cites [1] Long, 2013, Audit of maternal outcomes following introduction of an enhanced recovery in obstetric surgery (EROS) protocol for elective caesarean section, Int J Obstet AnesthNot checked yet

  Not checked in the free run.

Classified as probably not a substantial claim.

Recommendations were based not only on the quality of evidence but also on the balance between desirable and undesirable effects.

“Recommendations were based not only on the quality of evidence (high, moderate, low, and very low) but also on the balance between desirable and undesirable effects.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

In some cases, strong recommendations may be obtained from low-quality data, and vice versa.

“In some cases, strong recommendations may be obtained from low-quality data, and vice versa.”

Classified as probably not a substantial claim. May combine two claims.

The literature search (2017 to September 2024) was conducted using Embase, PubMed MEDLINE, EBSCO CINAHL, Scopus, and Web of Science databases to search controlled vocabulary and key words, focusing on randomized clinical trials and large observational studies (>800 patients).

“The literature search (2017 to September 2024) was conducted using the Embase, PubMed MEDLINE, EBSCO CINAHL (Cumulative Index of Nursing and Allied Health Literature), Scopus, and Web of Science databases to search controlled vocabulary (medical subject headings) and key words that included”

Classified as probably not a substantial claim.

Interventions were selected based on expert consensus using the Delphi method.

“Interventions were selected based on expert consensus using the Delphi method.”

Classified as probably not a substantial claim.

Owing to its efficacy and emerging safety profile, other studies have suggested that treatment with IV iron may be more likely than oral iron to reduce adverse patient outcomes.

“Owing to its efficacy and emerging safety profile, other studies have suggested that treatment with IV iron may be more likely than oral iron to reduce adverse patient outcomes.60,67e71”

• cites 60,67e71Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Classified as probably not a substantial claim.

Consensus was reached regarding the quality of evidence and strength of recommendation for each proposed intervention according to the GRADE system.

“Following a review of the evidence, a consensus was reached regarding the quality of evidence and the strength of recommendation for each proposed intervention according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The health consequences of tobacco smoke exposure during pregnancy have been well established.

“The health consequences of tobacco smoke exposure during pregnancy have been well established.117e120”

• cites 117e120Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

A higher risk for miscarriage was reported for pregnant patients with Sjögren's syndrome (risk ratio, 8.85; 95% CI, 3.10e25.26) and systemic lupus erythematosus (SLE) (OR, 4.90; 3.10e7.69).

“A higher risk for miscarriage was reported for pregnant patients with Sjögren's syndrome (risk ratio, 8.85; 95% CI, 3.10e25.26)and systemic lupus erythematosus (SLE) (OR, 4.90; 3.10e7.69).”

May combine two claims.

Pregnant patients with epilepsy have increased odds of developing severe preeclampsia, an embolism, disseminated intravascular coagulation or shock, cerebrovascular events, and severe mental health conditions.

“Particularly, pregnant patients with epilepsy have increased odds of developing severe preeclampsia, an embolism, disseminated intravascular coagulation or shock, cerebrovascular events, and severe mental health conditions.”

May combine two claims.

Preterm birth was associated with T1DM (OR, 4.36; 3.72e5.12) and SLE (OR, 2.79; 2.07e3.77).

“Preterm birth was associated with T1DM (OR, 4.36; 3.72e5.12)and SLE (OR, 2.79; 2.07e3.77).”

May combine two claims.

There was a higher risk for stillbirth in pregnant patients with T1DM (OR, 3.97; 3.44e4.58), IBD (OR, 1.57; 1.03e2.38), and celiac disease (OR, 1.57; 1.17e2.10).

“There was a higher risk for stillbirth in pregnant patients with T1DM (OR, 3.97; 3.44e4.58),IBD (OR, 1.57; 1.03e2.38),and celiac disease (OR, 1.57; 1.17e2.10).”

May combine two claims.

There was an increased risk for intrauterine growth restriction in pregnant patients with systemic sclerosis (OR, 3.20; 2.21e4.53) and celiac disease (OR, 1.71; 1.36e2.14).

“There was an increased risk for intrauterine growth restriction in pregnant patients with systemic sclerosis (OR, 3.20; 2.21e4.53)and celiac disease (OR, 1.71; 1.36e2.14).”

May combine two claims.

The 3 focused preoperative interventions are time-specific and may require reinterpretation or re-dosing due to common elective surgery delay issues.

“The 3 focused interventions are preoperatively time-specific and may required reinterpretation or re-dosing due to common elective surgery delay issues.121e155”

• cites 121e155Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

Multidisciplinary team-based medical and surgical care can modify the morbidity and mortality risks for pregnant person and fetal-neonates, but the direct impact on caesarean delivery is unknown.

“-Medical and surgical consideration: multidisciplinary team-based care is recommended and can modify the morbidity and mortality risks for pregnant person and fetal-neonates but the direct impact on caesarean delivery is unknown.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The European Society of Anesthesiology guidelines state that for scheduled cesarean delivery, patients can consume clear liquids up to 2 hours before surgery (including tea or coffee with a modest amount of milk) and 6 hours for solid foods.

“The European Society of Anesthesiology guidelines are more liberal and state that for scheduled cesarean delivery, patients can consume clear liquids up to 2 hours before surgery (including tea or coffee with a modest amount of milk) and 6 hours for solid foods.148”

• cites [148] Smith, 2011, Perioperative fasting in adults and children: guidelines from the European Society of Anaesthesiology, Eur J Anaesthesiol sourceNot checked — no full text of the source

May combine two claims.

Low birth weight babies were reported for pregnant patients with SLE or systemic sclerosis diagnoses (OR, 5.95; 4.54e7.80 and OR, 3.80; 2.16e6.56, respectively).

“Low birth weight babies were reported for pregnant patients with SLE or systemic sclerosis diagnoses (OR, 5.95; 4.54e7.80and OR, 3.80; 2.16e6.56,respectively).”

May combine two claims.

Using a nonparticulate CHO drink does not delay gastric emptying beyond 2 hours before the scheduled surgery and may be beneficial preoperatively.

“This finding suggests that using a nonparticulate CHO drink does not delay gastric emptying beyond 2 hours before the scheduled surgery and may be beneficial preoperatively.156”

• cites [156] Popivanov, 2020, Gastric emptying of carbohydrate drinks in term parturients before elective caesarean delivery: an observational study, Int J Obstet Anesth sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The ACOG Practice Bulletin 75 recommends certain pre-admission and preoperative preventive measures to reduce infectious morbidity by treating remote infections, advising patients to shower or bathe (full body) with soap (antimicrobial or nonantimicrobial) or an antiseptic agent at least the night before or the morning of the abdominal surgery, and to not shave the abdominal incision area; however

“The ACOG Practice Bulletin 75,107 entitled Prevention of Infection After Gynecologic Procedures recommends certain pre-admission and preoperative preventive measures to reduce infectious morbidity by treating remote infections, advising patients to shower or bathe (full body) with soap (antimicrobial or nonantimicrobial) or an antiseptic agent at least the night before or the morning of the”

• cites [75] 2015, ACOG practice bulletin no 156: obesity in pregnancy, Obstet Gynecol sourceNot checked — no full text of the source
• cites [107] 2018, ACOG practice bulletin no. 190: gestational diabetes mellitus, Obstet Gynecol sourceNot checked — no full text of the source

May combine two claims.

Although the Centers for Disease Control and Prevention and other major guidelines do not specifically recommend CHG, its use as a pre-admission shower or bath antiseptic choice is based on limited evidence suggesting increased preventive efficacy when compared with either soap or placebo.

“Although the Centers for Disease Control and Prevention and other major guidelines do not specifically recommend CHG, its use as a pre-admission shower or bath antiseptic choice is based on limited evidence suggesting increased preventive efficacy when compared with either soap or placebo.143”

• cites [143] Berríos-Torres, 2017, Centers for Disease Control and Prevention guideline for the prevention of surgical site infection, 2017, JAMA Surg sourceNot checked — no full text of the source

Classified as probably not a substantial claim. May combine two claims.

The SOAP consensus statement and the ASA practice guidelines and Enhanced Recovery Canada state the minimum duration of fasting before scheduled cesarean delivery should be 2 hours for ingestion of clear fluids (including carbonated beverages and carbohydrate rich nutritional drinks), 6 hours after a light meal or milk, and 8 hours after a meal of fried foods, fatty foods, or meat.

“The SOAP consensus statement and the ASA practice guidelines and Enhanced Recovery Canada state the minimum duration of fasting before scheduled cesarean delivery should be 2 hours for ingestion of clear fluids (including carbonated beverages and carbohydrate rich nutritional drinks), 6 hours after a light meal or milk, and 8 hours after a meal of fried foods, fatty foods, or meat.144e147”

• cites 144e147Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

Fetuses and infants of pregnant patients with epilepsy have elevated odds of mortality (aOR, 1.20; 95% CI, 1.05e1.38) and severe neonatal morbidity (aOR, 1.48; 95% CI, 1.40e1.56).

“Fetuses and infants of pregnant patients with epilepsy have elevated odds of mortality (aOR, 1.20; 95% CI, 1.05e1.38)and severe neonatal morbidity (aOR, 1.48; 95% CI, 1.40e1.56).”

May combine two claims.

The safety of administering a routine oral carbohydrate drink ahead of a scheduled cesarean delivery in pregnant patients with GDM was demonstrated in a recent RCT in which lower rates of intraoperative hypoglycemia were noted among patients exposed to the intervention without differences in neonatal hypoglycemia.

“In addition, the safety of administering a routine oral carbohydrate drink ahead of a scheduled cesarean delivery in pregnant patients with GDM was demonstrated in a recent RCT in which lower rates of intraoperative hypoglycemia were noted among patients exposed to the intervention without differences in neonatal hypoglycemia.114e116”

• cites 114e116Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

In analyses restricted to women or pregnant persons with epilepsy, pregnant patients exposed to antiseizure medication (ASM), when compared with those who were not exposed, had higher odds of severe morbidity (aOR,1.24;95% CI, 1.10e1.48) and their neonates had increased odds of mortality and severe morbidity (aOR, 1.37; 95% CI, 1.23e1.52).

“In analyses restricted to women or pregnant persons with epilepsy, pregnant patients exposed to antiseizure medication (ASM), when compared with those who were not exposed, had higher odds of severe morbidity (aOR,1.24;95% CI, 1.10e1.48)and their neonates had increased odds of mortality and severe morbidity (aOR, 1.37; 95% CI, 1.23e1.52).”

May combine two claims.

One RCT that compared bupropion with placebo for smoking cessation did not identify reductions in smoking with the intervention, although financial incentives and multidisciplinary care approaches have been shown to be successful.

“One RCT that compared bupropion with placebo for smoking cessation did not identify reductions in smoking with the intervention, although financial incentives and multidisciplinary care approaches have been shown to be successful.125e129”

• cites 125e129Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

The incidence of preeclampsia has been reported to be higher in pregnant patients with type 1 diabetes mellitus (T1DM) (OR, 4.19; 3.08e5.71) and SLE (OR, 3.20; 2.54e4.20).

“The incidence of preeclampsia has been reported to be higher in pregnant patients with type 1 diabetes mellitus (T1DM) (OR, 4.19; 3.08e5.71)and SLE (OR, 3.20; 2.54e4.20).”

Probably not a substantial claim: may not pass S3 (load-bearing).

The review reported an association between 12 autoimmune conditions and 16 adverse pregnancy outcomes.

“The review reported an association between 12 autoimmune conditions and 16 adverse pregnancy outcomes.”

May combine two claims.

This multinational study showed that pregnant patients with epilepsy were at a considerably higher risk for severe patient and perinatal outcomes and an increased risk for death during pregnancy and the postpartum period.

“This multinational study showed that pregnant patients with epilepsy were at a considerably higher risk for severe patient and perinatal outcomes and an increased risk for death during pregnancy and the postpartum period.”

Probably not a substantial claim: may not pass S3 (load-bearing).

USPSTF (2021) recommends screening persons with overweight and obesity for prediabetes and type 2 diabetes in adults aged 35e70 y.

“USPSTF(2021): recommend screening persons with overweight and obesity for prediabetes and type 2 diabetes in adults aged 35e70 y.”

• cites USPSTF(2021)Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

None of the studies was multicenter, and most were of poor quality with inadequate allocation concealment and a lack of adherence to intention-to-treat analyses.

“Overall, none of the studies was multicenter, and most were of poor quality with inadequate allocation concealment and a lack of adherence to intention-to-treat analyses.”

May combine two claims.

Most of the outcomes studied were not clinically significant, and only 1 study evaluated the effect of CHO loading on general recovery.

“Most of the outcomes studied were not clinically significant, and only 1 study evaluated the effect of CHO loading on general recovery.”

Probably not a substantial claim: may not pass S3 (load-bearing).

USPSTF (2021) concludes with moderate certainty that there is a moderate benefit to screening for gestational diabetes at 24 weeks of gestation or later to improve pregnant persons and fetal outcomes.

“USPSTF (2021): concludes with moderate certainty that there is a moderate benefit to screening for gestational diabetes at 24 weeks of gestation or later to improve pregnant persons and fetal outcomes.”

• cites USPSTF (2021)Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.